The deformities in the digits are caused by displacement or rupture of the normal tendon anatomy.

History

The disease often is insidious in onset, with the gradual development of generalized symptoms and joint aches and stiffness.

Physical Exam

The presentation of patients with rheumatoid arthritis and other inflammatory arthropathies is variable and subtle.

Important aspects on the physical examination include:

Joint effusion

Boggy synovium

Ulnar drift of the fingers

Subluxation of the MCP joint

Painful, restricted ROM of joints

Tests

Lab

No test is specific for the diagnosis, although serum rheumatoid factor is present in 2/3 of patients.

Normochromic, normocytic anemia occurs.

Increased ESR and C-reactive protein are seen in nearly all patients.

These levels can be followed as a marker of disease progression and the efficacy of therapy.

Synovial fluid analysis confirms an inflammatory arthritis, but it is nonspecific.

Additional rheumatologic studies, including hepatitis profile, antinucleic antibodies, anti-double-stranded DNA, anti-Smith (and anti-Jo-1 antibodies), also should be analyzed to exclude the possibility of other rheumatologic processes.

Imaging

Imaging is not helpful early in the disease, but, as the disease progresses, loss of articular cartilage, bone erosions, and juxtaarticular osteopenia are seen on roentgenograms of the affected joints.

Plain radiographs show subluxed or dislocated MCP or PIP joints.

Pathological Findings

Chronic inflammation of the synovial tissue with subsequent bone and cartilage destruction.

Differential Diagnosis

Osteoarthritis

Acute rheumatic fever

Ochronosis

Systemic lupus erythematosus

Polymyalgia rheumatica

Juvenile rheumatoid arthritis

Spondyloarthropathies

Psoriatic arthritis

Infectious arthritis

Treatment

General Measures

Early involvement of a rheumatologist can be helpful in making the diagnosis and managing the patient.